Course Withdrawal Form
    Complete this form in its entirety and click submit. Your academic advisor will contact you at the e-mail address or phone number you have entered for any additional information or counseling. Please review the following information prior to submission:

    Refund schedule

    Timeline for withdrawal without academic penalty


    Complete this form and click submit.

    * Required Information

  • Your Contact Information

  • First Name:*

    Last Name:*

    Country:*

    Address:*

    City:*

    State/Province:*

    Zip/Postal Code:*

    Primary Phone Number:*
    Format: 555-111-9876

    Alternate Phone Number:
    Format: 555-111-9876

    Time Available:

    Email Address:*


  • Request

  • Is this a course or program withdrawal?*


    If course, which course(s) are you withdrawing from?

    Withdraw Course 1:

    Withdraw Course 2:

    Withdraw Course 3:

    Withdraw Course 4:

    Advisor Name:*

    Withdraw reason:*

    Explanation:*




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